Healthcare Provider Details

I. General information

NPI: 1023825239
Provider Name (Legal Business Name): DESTINY ANGEL WILLIAMS LGPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1539 CHARLESTOWN DR
EDGEWOOD MD
21040-2207
US

IV. Provider business mailing address

1539 CHARLESTOWN DR
EDGEWOOD MD
21040-2207
US

V. Phone/Fax

Practice location:
  • Phone: 202-222-8474
  • Fax:
Mailing address:
  • Phone: 202-222-8474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLGP14721
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberCER-181620-M7G0Q4
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: